Individual
MAYA JAGASIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1909 QUAIL RUN CC CT, NORMAL, IL 61761-5210
(309) 451-3699
(904) 805-1302
Mailing address
1909 QUAIL RUN CC CT, NORMAL, IL 61761-5210
(309) 451-3699
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36053763
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360537633
—
IL
01
—
P00195135
RAILROAD MCR
—
Enumeration date
05/30/2006
Last updated
03/17/2008
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